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In Middle Age, Jennifer Embraces Moderation!

Wednesday, May 4, 2016 - 20:15

We all did crazy things in our youth. Some people I knew drank more than they should have, some did drugs, others rock climbed (well, actually, I did that one). My craziness rested on the fact that I liked to exercise. When I say exercise, I mean exercise a lot, and HARD. I constantly made pacts with myself – the only person I competed against – to ride up the Poplar Plains hill to St. Clair Avenue (a long, gradual climb that many cyclists dread) without shifting once to a lower gear, or to hike the West Coast Trail with a backpack that was considerably heavier then it should have been for what has been aptly termed the most difficult hike on the planet. Or go for four-hour trail runs. In sum, I could exercise harder, and longer, than most. And I loved it. When I was younger, I had standards for myself which I never would have had for any client. I was always a high achiever, and my athletic life was no exception.

Alas, I am no longer in my 20s – or my 30s. While regular exercise continues to be a source of pleasure, escapism, and stress reduction, at the age of 45 (soon to be 46!) I am no longer able to make every workout hard. My body would break down surely and quickly. It now takes me much longer to recover from the track repeats and high intensity treadmill intervals I do in order to stay fast as a middle aged runner. I need days off exercise, and have learned to see recovery as an integral component of the training program – something I have always taught to my clients with fibromyalgia and chronic pain. I need to space out my runs to stave off fatigue and overtraining syndrome. These days, I rely on my bike for healthy doses of moderate intensity exercise during which I can pleasantly hear my heart beating, but not beating outside my chest. I save this sensation – which I absurdly love! – for hard runs. This approach led to my second best half marathon time at the Scotiabank Waterfront Marathon in 2014 of 1:36:16 - 10th in my age category (picture below)! - and, the same year, two of my best 10k times ever.

My many years of practice as a medical exercise specialist impart a deep appreciation for the healing power of exercise - of any intensity. I have seen time and again how a lack of physical activity truly damages the human body, and conversely, how exercise has the capacity to heal.

So, as a middle aged sub-elite long distance runner, I have learned to embrace moderation. And I have stayed fast – and injury free - because of it.

Sleep Deprivation and Dehydration Contribute to Obesity

Thursday, February 4, 2016 - 14:30

Obesity, defined as a body mass index (BMI) of 30 or above, increases the risk of a multitude of chronic health conditions including Type 2 diabetes, hypertension, coronary heart disease, endometrial, breast, and colon cancers, dyslipidemia (high cholesterol and triglycerides, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, and osteoarthritis of the knee. It is now understood that most people do not gain large amounts of weight at once – rather, people usually gain a few pounds a year until they find themselves facing a cumulative substantial weight gain many years down the road. This is exacerbated by the unfortunate fact that metabolism slows as a result of the aging process, leading to increased difficulty in weight loss as one gets older. In fact, in order to maintain the same weight as we age requires reduced calorie intake/increased physical activity. For this reason, it is always better to circumvent weight gain in the first place.

Sleep fulfills the following three major functions:

It serves as the energy restoration period from daytime activities

It affords bodily protection at night when sensory capacities are down-regulated

It allows the brain to consolidate experiences and memories for learning

Geoff Colvin, in his book Talent is Overrated, writes about a study of violinists at an elite music school which tried to answer the question of why some musicians are better than others. The study looked at three different groups: the very best students, the good students, and students in a separate program stream that had lower admission standards. Although Colvin’s book actually examines the concept of deliberate practice in success, not sleep, it was interesting to note that the top group of violinists slept more than the other two groups.

In terms of obesity, other contributing factors have been identified. Chronic sleep deprivation, exceedingly common in today’s Western world, has been recognized as one of the causes of obesity. It is also possible that obesity itself may impact on the quality and duration of sleep. Most adults require 7-8 hours of sleep, and chronic sleep debt is defined as having more than 4 but less than 7 hours per night. I am not speaking of acute sleep deprivation, which happens infrequently during long travels, scrambling to finish a piece of work last minute, or waking up with a sick child. Chronic sleep is exactly that: long periods of time in an individual’s life when insufficient sleep is experienced.

The three major processes linking chronic sleep restriction to obesity are metabolic and neuroendocrine function, glucose regulation and waking behaviour.

Metabolic and Neuroendocrine Function

It has been found that chronic sleep restriction elevates the sympathetic nervous system, increasing evening cortisol production. This in turn can increase food intake and the accumulation of abdominal fat. In addition, sleep debt is associated with lower levels of leptin secretion. Leptin is secreted from fat cells and transmits energy balance messages to the hypothalamus (the brain centre for hunger). As leptin levels decrease, the hypothalamus interprets the message that the fat cells need more food and directs the body to eat more. Moreover, insufficient sleep leads to a significant increase in ghrelin, a hunger hormone produced and secreted from the stomach. Higher than normal circulating ghrelin levels stimulate hunger and food intake.

Glucose Regulation Processes

Chronic sleep deprivation is connected to impaired glucose metabolism, leading to a strong association between sleep debt and diabetes. Impaired glucose regulation is often coupled with weight gain – glucose plays an important role in regulating appetite. When glucose metabolism is compromised, which occurs with sleep debt, glucose utilization in parts of the brain becomes impaired. This promotes the hunger response.

Waking Behavior

This is simple – more time awake means more opportunities to eat. Due to the ubiquity of technology people often find themselves awake later than they would have been in years past. Moreover, many people find themselves tired during the day precisely because of inadequate sleep, and compensate for this by consuming caffeinated beverages to stay alert. This creates a vicious cycle in which it then becomes difficult to fall asleep at night.

Exercise Specialist Recommendations:

Avoid exposure to bright light, television, computer, or tablets one hour before bedtime.

Avoid stimulating conversations, either in person or by phone, one hour before bedtime.

Do not do work one hour before bedtime.

Limit naps to 30 minutes, and try to take them earlier in the day.

Exercise in the mid or late afternoon – this has been shown to have positive effect on sleep quality.

Do not smoke or use nicotine before bed, as nicotine keeps many people awake.

Sleep in a very dark room.

Block out noise with earplugs.

Keep ambient temperature cool.

Avoid drinking lots of fluids after dinner.

Establish a relaxing bedtime routine that might include reading, drinking herbal tea, quiet time with your partner if applicable, and mediation or simple deep breathing.

Changing behaviour of any sort is very hard to do – but diligent adherence to the above set of recommendations will enable the chronically sleep-deprived to learn what it feels like to be truly well-rested. Once this experienced, there is no turning back.

Exercise Solutions for Those with Zero Time

Friday, January 1, 2016 - 14:30

The number one reason people give for not exercising is that they don’t have enough time to fit in regular workouts. A critical aspect of what I do with my clients is work through these perceived barriers to find solutions that work for each individual. This may include:

Fragmented, or discontinuous, exercise. Dividing a daily exercise goal into several smaller segments that can be slotted into a busy schedule is an effective training technique for busy clients, and also for those who cannot tolerate long bouts of exercise for various health reasons. Planning this type of program effectively is a bit of an art, and a science. It is worth mentioning that discontinuous exercise has a more meaningful impact on high blood pressure than a single daily workout.

Make a realistic determination about the exercise volume that a client can include in his/her week. People are much more likely to comply with recommendations that seem achievable, than those that seem impossible to incorporate. An honest conversation about what is truly realistic is often necessary in order to create a workable plan.

Being flexible about exercise intensity. While we know that higher intensity exercise generates more favourable health outcomes, many people do not like to do it. They may find it uncomfortable and, as a result, avoid exercising. The good news is that moderate intensity exercise also generates advantages, so some individuals are happy to exchange some degree of benefit for a more pleasurable fitness experience. “Not enough time” as an identified barrier often disappears when the client begins to positively anticipate exercise sessions.

Monitor exercise intensity. Using various tools to monitor and adjust exercise intensity makes for higher quality workouts. Ensuring that each and every workout has a specific purpose translates into substantially better results.

Incorporate a low volume of high intensity training. Short bouts of very high intensity interval training (HIIT) can produce marked health benefits at a fraction of the time required to attain these advantages through moderate intensity programming. Twice weekly sessions of 20-30 minutes that include all-out intervals on a treadmill, elliptical trainer, or stationary cycle/spin bike, can solve the “zero time” issue. Biking up a steep hill, or running track repeats, are also options. The only caveat is that this type of exercise requires a good baseline fitness level, and experience with the chosen exercise modality. For example, someone who does not have running experience should not engage in fast running until he/she has some measure of experience specific to the sport. Biking, being low impact, is more forgiving – but the risk of injury should always be taken into consideration.

Active transportation. Biking, walking, or even running to work can naturally incorporate exercise into a daily routine with no extra time commitment whatsoever. I myself bike everywhere I can as long as there isn’t snow or ice, knowing that even if I miss a scheduled workout I will still have at least 45 minutes of exercise under my belt that day, and often much more than this. I have started to notice more and more people running to work/school recently, often with backpacks which are specially designed for this purpose. And, being extremely fortunate to reside in the extremely liveable downtown of a big city, witness countless people walking to where they need to go.

Take stairs as a rule. I tell many of my clients who can tolerate stair climbing to do so as much as possible. For those who are physically able, I recommend that they make a pact with themselves to only take the stairs. Recently, a new client with elevated blood pressure who followed this advice was able to lower her blood pressure to low-normal range without the use of anti-hypertensive medications!

A cognitive-behavioral framework of practice. Our thoughts, feelings and behaviors are inextricably linked, and altering one usually affects the others. As an Ontario Registered Social Worker, in addition to being a Certified Medical Exercise Specialist and Certified Personal Trainer, I have a deep understanding of how cognition – what we think – affects what we do, and vice versa. Even though many people do not feel an intrinsic motivation to exercise, even short workout sessions can quell anxiety and change thought processes. Explaining this mechanism encourages my clients to take small steps toward beneficial lifestyle changes.

Which is Better, Walking or Running?

Tuesday, December 1, 2015 - 14:30

Walking and running are the most popular physical activities for American adults. However, it has long been debated whether one is preferable to the other in terms of improving health. Now a variety of new studies that compared running directly against walking are providing some answers. Their conclusion? It depends on what you are hoping to accomplish.

For those whose goal is weight control running is superior. In a study published last month in Medicine & Science in Sports & Exercise titled “Greater Weight Loss From Running than Walking,” researchers combed survey data from 15,237 walkers and 32,215 runners enrolled in the National Runners and Walkers Health Study — a large survey being conducted at Lawrence Berkeley National Laboratory in Berkeley, California. Participants were asked about their weight, waist circumference, diets and typical weekly walking or running mileage both when they joined the study, and then again up to six years later. The runners were almost uniformly thinner than the walkers when each joined the study, and they stayed that way throughout. That is to say, over the years the runners maintained their body mass and waistlines far better than the walkers. The difference was particularly notable among participants over 55. Runners in this age group were not running a lot and, in general, were barely expending more calories per week during exercise than older walkers. However, their body mass indexes and waist circumferences remained significantly lower than those of age-matched walkers.

Why running should better aid weight management than walking is not altogether clear. It might seem obvious that running, being more strenuous than walking, burns more calories per hour. But in the Berkeley study and others, when energy expenditure was approximately matched — when walkers head out for hours of rambling and burn the same number of calories over the course of a week as runners — the runners seem able to control their weight better over the long term. One reason may be the effect of running on appetite, as another intriguing, if small, study suggests. In the study, published last year in The Journal of Obesity, nine experienced female runners and 10 committed female walkers reported to the exercise physiology lab at the University of Wyoming on two separate occasions. On one day, the groups ran or walked on a treadmill for an hour. On the second day, they all rested for an hour. Throughout each session, researchers monitored their total energy expenditure. They also drew blood from their volunteers to check for levels of certain hormones related to appetite. After both sessions, the volunteers were set free in a room with a laden buffet and told to eat at will. The walkers turned out to be hungry, consuming about 50 calories more than they had burned during their hour long treadmill stroll. The runners, on the other hand, picked at their food, taking in almost 200 fewer calories than they had burned while running. Blood tests demonstrated that, after exercising, the runners had significantly higher blood levels of a hormone called peptide YY, which has been shown to suppress appetite. Conversely, the walkers did not have increased peptide YY levels, their appetites remaining hearty.

On other measures of health, however, new science shows that walking can be at least as valuable as running — and in some instances, more so. A study published this month that again plumbed data from the Runners and Walkers Health Study found that runners and walkers had equally diminished risks of developing age-related cataracts compared with sedentary people, an unexpected but excellent benefit of exercise.

Finally, in possibly the most reassuring of the new studies, published last month in Arteriosclerosis, Thrombosis and Vascular Biology and again utilizing numbers from the Runners and Walkers Health Study, runners had far less risk of high blood pressure, unhealthy cholesterol profiles, diabetes and heart disease than their sedentary peers. But the walkers were doing even better. Runners, for instance, reduced their risk of heart disease by about 4.5 percent if they ran an hour a day. Walkers who expended the same amount of energy per day reduced their risk of heart disease by more than 9 percent.

Of course, few walkers match the energy expenditure of runners. “It’s fair to say that, if you plan to expend the same energy walking as running, you have to walk about one and a half times as far and that it takes about twice as long,” said Paul T. Williams, a staff scientist at Lawrence Berkeley National Laboratory and the lead author of all of the studies involving the surveys of runners and walkers. On the other hand, people who begin walking are often more unhealthy than those who start running, and so their health benefits from the exercise can be commensurately greater. “It bears repeating”, Dr. Williams said “that either walking or running is healthier than not doing either”.

For confirmation, consider one additional aspect of the appetite study. The volunteers in that experiment had sat quietly for an hour during one session, not exercising in any fashion. And afterward they were famished, consuming about 300 calories more than the meager few they had just burned.

Reference:

Reynolds, Gretchen. Is It Better to Walk or Run? The New York Times, May 29 2013.

Exercise Specialist Recommendations:

Walk as much as possible.

Run if you are able.

Understand that the most important factor in good health is staying physically active throughout the lifespan. With this in mind, create a workout routine that is enjoyable, and most importantly, sustainable over the long term.

Utilizing Exercise to Improve Mental Health

Sunday, November 1, 2015 - 14:30

In recent years, something has happened which is quite incredible – the taboo subject of mental health has come into the open. Individuals who suffer from depression, anxiety disorders, and other mental health conditions are more likely to tell others about their struggles. To be sure, many people still prefer to keep their issues private, but highly publicized events and campaigns like Clara’s Big Ride and Bell Canada Let’s Talk are doing a wonderful job in the monumental task of destigmatization these mental health problems and educating the public so those who suffer know they are not alone.

Exercise has a proven track record of assisting in the management of mental health issues. Since the 1980s, a great deal of research has been published that demonstrates that exercise can help relieve anxiety and depression. While in many cases physical activity is part of a holistic treatment plan that also includes medication and counselling, in mild cases it can be a stand-alone treatment. Always consult with your doctor before implementing something new, or adjusting an existing protocol.

How does exercise do this? We are actually not quite sure. While copious studies show an effect, “an analysis of the findings from only the most methodologically robust studies showed a weaker effect that was not statistically significant. So, more high-quality trials are required to clarify the effectiveness of exercise as a treatment for depression”. However, growing evidence indicates that physical activity can be a valuable adjunctive therapy, particularly for people with severe symptoms. Researchers from the University of Texas Southwestern and the Cooper Institute in Dallas, found that exercise can serve as a supplemental treatment for 50% of patients with depression who have not been cured by a single antidepressant medication (Trivedi et al. 2011). The amount and type of exercise need to be customized to the individual, as many people who start on an antidepressant medication feel better after they begin treatment, but “still don’t feel completely well or as good as they did before they became depressed”.

Interestingly, data analysis showed that women with a family history of mental illness benefited more from a moderate exercise regimen, while intense exercise helped those with no family history of depression. In men, regardless of family history, symptoms improved more with a high volume of exercise. This may be why the effect of exercise on mental health is hard to capture with well-controlled studies, which do not individualize programs for each study participant in the quest to capture a statistically significant result.

According the science, exercise improves may improve mental health in the following ways:

By raising tolerance for emotional stress. Since exercise is stressful, regular exercise increases a person’s resilience toward other forms of physical and emotional stress.

By increasing familiarity with physical stress. For some anxiety sufferers, an elevated heart rate, profuse sweating, chills, and other stress symptoms that can occur during an anxiety attack are, on their own, upsetting. By exercising regularly, people can learn to control their experience of physiological stress, making these symptoms less frightening.

By boosting self-efficacy. People who master a new skill improve self-efficacy, which subsequently leads to higher self-esteem

By fostering social contact. Social interactions can improve mood, and lead to opportunities to spend time with others. Encouragement from friends and family is also beneficial.

By increasing exposure to the outdoors, sunlight and green environments. Engaging in outdoor exercise (“green exercise”) helps to lift mood. As well, exposure to sunlight, even on darker days, can raise neurotransmitters levels and elevate mood.

By diverting negative thinking. People with depression and anxiety usually get stuck in negative thought cycles. Exercise, especially mindful exercise, may be diversion from self-rumination toward engagement with pleasurable experiences.

By encouraging engagement instead of avoidance. Focusing on pursuits involving physical activity provides value in itself. A structured program encourages participation instead of withdrawal, and teachers persistence. This lesson in engagement can help people with anxiety to overcome avoidance in other arenas of life.

If you suffer from anxiety or depression, try exercise. Start with small amounts with no pressure. You may be pleasantly surprised at the result.

What Makes People Gain Weight?

Thursday, October 1, 2015 - 14:30

It is no secret that we have been battling a major obesity epidemic in North America for the last 20 years or so. Research shows that two-thirds of Americans are overweight or obese (Ogden et al. 2014), a health condition associated with hypertension, cardiovascular disease, diabetes, depression and various cancers (breast, endometrial, colon and prostate) (Malik, Schultz & Hu 2006). Furthermore, studies find that individuals tend to gain weight slowly over time after age 50—adding approximately 1 pound per year (Mozaffarian et al. 2011). Obesity is not exclusive to North America, however. In 1995, there were an estimated 200 million obese adults worldwide and another 18 million children under the age of 5 classified as overweight. As of 2000, the number of obese adults has increased to over 300 million. Contrary to conventional wisdom, the obesity epidemic is not restricted to industrialized societies; in developing countries, it is estimated that over 115 million people suffer from obesity-related problems.

In the US, obesity-related health care costs $190 billion annually, representing five to ten percent of all medical spending. Roughly half of these costs are paid through public expenditures. The medical costs for people who are obese are dramatically higher than those of normal weight (CSPI, 2015).

With this in mind, what are the main factors that cause people to gain weight? There are six factors that predict weight gain over the North American lifespan.

There are foods that help with weight management. Eating foods such as nuts, whole grains, fruits, vegetables, yogurt, diet (zero-calorie) soda, cheese and milk (low-fat, skim and whole) appeared to curb weight gain. These foods have slower digestion rates (some being high in fiber) and appear to enhance satiety—the feeling of being full after a meal. These foods can replace other, more highly processed foods in the diet, creating a reasonable biological mechanism whereby people who eat more fruits, nuts, vegetables and whole grains may gain less weight over time (Mozaffarian et al. 2011).

Consumption of Sugar-Sweetened Beverages

Sugar-sweetened beverages (SSBs) have little nutritional benefit and are reportedly the greatest provider of kilocalories in the American diet (Dennis, Flack & Davy 2009). In 2006, Malik, Schultz & Hu concluded that these drinks accounted for approximately 8%–9% of total energy intake in children and adults. SSBs contain carbohydrates of various forms, such as high-fructose corn syrup, sucrose and artificial sweeteners. Drinking SSBs has little impact on satisfying hunger (Malik, Schultz & Hu 2006), so people can consume large quantities without suppressing their appetite (Mattes 2006).

The body’s response to carbohydrate (of equal caloric value) differs depending on whether it is liquid or solid. In a crossover study, DiMeglio & Mattes (2000) found that people who drank SSBs gained significantly more weight than they did when consuming a comparable amount of carbohydrate in solid form. Subjects participated in both treatments, following each for 4 weeks, and the SSB treatment produced double the fat mass compared with the solid-carbohydrate intervention. Both carbohydrate sources were the caloric equivalent to three 12-ounce sodas per day in both treatments (DiMeglio & Mattes 2000).

According to extensive research compiled by the Centre for Science in the Public Interest (CSPI), an extra soft drink a day increases a child’s risk of becoming obese by about 60 percent; and adults who drink one sugar drink or more per day are 27 percent more likely to be overweight or obese than non-drinkers, regardless of income or ethnicity. In addition, people who consume sugar drinks regularly—one to two cans a day or more—have a 26 percent greater risk of developing type 2 diabetes than people who rarely consume such drinks. The risks are even greater for young adults and Asians. Furthermore, daily consumption of sugar drinks for six months increases fat deposits in the liver by 150 percent, which directly contributes to both diabetes and heart disease (CSPI, 2015)

Sleeping Too Little, or Too Much

Although more clinical trials are needed, several epidemiological studies suggest that weight gain is influenced by sleeping less than 7 hours or more than 8 hours per night (Marshall, Glozier, and Grunstein 2008). According to Marshal and colleagues, people who sleep too little develop chronically impaired glucose metabolism, steadily contributing to obesity. In addition, sleep deprivation significantly lowers circulating levels of the hormone leptin and increases circulating levels of the hormone ghrelin—both effects that promote food intake.

Excessive TV Watching

Length of time spent watching television is highly correlated with weight gain, especially in young people (Chapman et al. 2012). Chapman and associates tell us 58.9% of Americans watch television for more than 2 hours per day. According to these authors, epidemiologic studies reveal that those who regularly watch more daily television per day tend to

snack more while watching;

have higher overall caloric intake of foods; and

consume more energy-dense foods.

All these choices lead to weight gain. Conversely, children watching less than one hour of TV a day are associated with lower body weight, body mass index, skinfold thickness and fat mass, emphasizing the importance of lifestyle in weight gain (Chapman et al. 2012).

Overconsumption of Alcohol

Alcohol is very energy-dense—at 7 kcal per gram, it is second only to fat, with 9 kcal per gram; this creates a multitude of health issues. Aside from the pharmacological effects on the brain and on hormone fluctuation, the additional kilocalories from alcohol do not seem to replace energy consumption from other sources (Yeomans 2010). Therefore, energy consumption from alcohol augments overall daily calorie intake.

Yeomans adds that alcohol consumed before or with meals tends to increase food intake, probably by enhancing the short-term rewarding effects of food. Uniquely, Yeomans cites epidemiological data suggesting that alcohol in moderation can protect against obesity, specifically in women. This means that alcohol is can be considered dose-dependent and should be monitored closely, especially while eating.

Not Engaging in Enough Physical Activity

In studying 15-year trends, scientists have noted an inverse relationship between walking and weight gain (Gorden-Larsen et al. 2009), suggesting that the more people walk, the less likely they are to gain weight. The researchers point out that older Amish people who walk an average of 18,000 (men) and 14,000 (women) steps a day have very low rates of obesity. They suggest that adding 2–4 hours of walking per week is an attainable movement target.

Despite the documented benefits of exercise, only half of Americans (51.6%) participate in the recommended volume (150 minutes per week) of moderate aerobic activity during the week, while only 29.3% do muscle-strengthening activities at least 2 days per week. Furthermore, just 20.6% of U.S. adults (23.4% men and 17.9% women) meet both the aerobic and muscle-strengthening guidelines (CDC 2011). This data can be extrapolated to Canada. This means that the majority of North Americans trying to lose or maintain weight will struggle because they are not meeting the minimum physical activity guidelines.

Exercise Specialist Recommendations:

Watching too much TV or other screens, not getting enough sleep, drinking too much alcohol and too many sugar-sweetened beverages, eating high-calorie foods and eschewing physical inactivity indicate an obesogenic lifestyle and should be targeted in a behavior-change plan designed to prevent weight gain.

For many people, changing one element at a time is less stressful and engenders a more successful outcome than trying to address all factors simultaneously.

Successfully changing one factor can create cross-over success in other areas. For example, drastically reducing alcohol intake by itself can result in weight loss, making exercise more comfortable.

Success can by stymied by an unsupportive environment. Try your best to get loved on board with your efforts, or join an online community of others who are engaged in behavioural lifestyle change.

Weight training for a period of time (for example, 8 weeks) can build up strength and stamina, making cardiovascular exercise such as walking better tolerated.

Do whatever you must to protect sleep. Sleep in a very dark room, go to bed at the same time each night, wear earplugs if your sleep is interrupted by a noisy bed partner, and avoid blue-lit screens (phone, ipad, computer) in the hour before bed.

Eschew sugar-sweetened drinks at all costs, and make consumption of these a very occasional treat. If you enjoy Coke, share one can with a friend/partner a week. Sugar-sweetened drinks are deadly. Artificially-sweetened drinks are also to be avoided, as recent research shows that they impair glucose metabolism as well, and may lead to increased caloric intake from other foods.

Know that weight management is a long- term prospect. If you are over 50, be realistic and focus your efforts on weight maintenance, instead of weight loss.

Hypertension – The Epidemic of High Blood Pressure

Tuesday, September 1, 2015 - 14:30

Hypertension is one of the most prevalent chronic diseases in North America. Five million Canadian adults have high blood pressure, representing 19 percent of the adult population, and a further 20 percent of Canadian adults have pre-hypertension. Of Canadians with high blood pressure, 83 percent are aware of their condition and 17 percent are unaware. Hypertension becomes more common as people age, evidenced by the sobering statistic that 53 percent of Canadians aged 60 to 79 suffer from the condition. Women in particular should be alarmed, as hypertensive females have a 3 to 5 times greater risk of developing heart disease than women with normal blood pressure. (Statistics from the Heart and Stroke Foundation) Hypertensive individuals of both genders are 3-4 times more likely to develop coronary artery disease, and up to 7 times more likely to have a stroke.

Exercise is now recognized as an important part of therapy for controlling hypertension. While we know that aerobic exercise reduces both systolic and diastolic blood pressure by an average of 10 mmHg, how this happens is not completely understood. It appears that exercise reduces cardiac output, and reduces the total peripheral resistance of blood vessels. Less resistance inside blood vessels means that the diameter of these vessels increases – meaning that the heart does not need to work as hard to pump blood to the body.

Exercise Specialist Recommendations:

Focus on weight management. Many people with hypertension are overweight or obese. For this reason, non-drug therapy should be used as a first line treatment. This includes regular exercise, as well as salt restriction and other dietary modifications.

Do not hold your breath when exercising! This is called the Valsalva Maneuver, and will increase blood pressure. Try to focus on regular, smooth breathing.

Weight train! Resistance training should supplement endurance training. However, do not lift heavy weights – keep the resistance low, and the repetitions high.

Use the Rate of Perceived Exertion to monitor exercise intensity. This is estimating how hard you are working on a scale of 1 to 10 – 10 being an intensity you could not be able to sustain for longer then about 60 seconds. Anti-hypertensive medications, primarily beta-blockers, chemically lower heart rate, so using heart rate prediction formulas will not be accurate. People with hypertension should exercise at a 4-6 out of 10 in terms of intensity.

Monitor blood pressure before and after exercise for the first few weeks. Systolic blood pressure (the upper number) should go up with aerobic exercise, but diastolic blood pressure (the lower number) should stay the same or go down slightly. An increase in diastolic blood pressure during exercise is a huge red flag and if this happens, consult your doctor as soon as possible.

Extend your warm-up and cool-down. Each should be about 10 minutes for hypertensive individuals.

Exercise at least four times per week. Gradually increase your workout sessions to 30-60 minutes. Exercise has a dose-response ratio when it comes to hypertension – the ideal is to burn between 1800 and 2200 calories per week. In order to do this, most people will need to exercise almost every day. A lower caloric expenditure will still be beneficial – but not to the same degree.

Schedule your workouts or they will not happen!!!

If you suffer from hypertension, talk to your doctor about how exercise can and should be part of your treatment plan. As your blood pressure drops, assess with your doctor whether your medication doses can be adjusted accordingly. Although hypertension is a serious health condition, an affirmative view can be taken if the diagnosis is a catalyst for positive lifestyle changes!

Exercise Improves Sleep, but it Takes Time

Saturday, August 1, 2015 - 14:30

Is it an urban myth that exercise improves sleep? No, according to the National Sleep Foundation’s 2013 report Sleep in America. By polling adults aged 23-60, it was learned that:

More than 75% of exercisers reported good or fairly good sleep in the weeks leading up to the poll, compared to 56% of the non-exercisers.

The majority of vigorous exercisers – defined as those who participate in cycling, swimming, running, or any competitive sports – rarely experienced insomnia symptoms. Half of non-exercisers said they woke during the night, and 24% had difficulty falling asleep every night or almost every night.

Paradoxically, the non-exercisers tended to feel the most “sleepy” on a regular basis and to have more symptoms of sleep apnea.

Those who sat for less than 8 hours per day were more likely to report “very good” sleep quality than those who sat for longer periods of time.

In the words of poll task force member Barbara A. Phillips, MD, MSPH, FCCP, “Exercise is beneficial to sleep. It’s time to revise global recommendations for improving sleep and put exercise…at the top of our list of healthy sleep habits”.

However, the relationship between sleep and exercise for people who suffer from chronic insomnia is more complicated. Aerobic exercise performed during the day won’t translate into better sleep that same night, according to Kelly Glazer Baron, a clinical psychologist and director of the behavioral sleep program at Northwestern University Feinberg School of Medicine. “It’s a long-term relationship. You have to keep at it and not get discouraged.” Most studies on the daily effects of exercise and sleep have been done with healthy sleepers, and Dr. Baron’s research is the first to demonstrate that aerobic exercise during the day does not result in improved sleep that same night when people have pre-existing sleep problems. Moreover, while poor sleep does not alter aerobic capacity it does make exercise feel much harder – which often prevents poor sleepers from adhering to an exercise program over the long term. Sleep and exercise have a positive influence on each other, and those who do not sleep well will probably not feel motivated to exercise.

So how does a person with insomnia reap the benefits of regular exercise on sleep patterns? Commit to an exercise program for 16 weeks. Through an analysis of sleep data from 11 women aged 57 to 70 from a 2010 clinical trial, Dr. Baron demonstrated the ability of aerobic exercise to improve sleep, mood and vitality over a 16-week period in middle-age-to-older adults with insomnia. People with insomnia have a heightened level of brain activity and it takes time to re-establish a more normal level of activity that facilitates sleep. As opposed to medications which induce sleep rapidly, exercise is probably a healthier way to improve sleep because it may address the underlying problem. For older adults – particularly older women, who have the highest rate of insomnia of any group - implementing an exercise program may be the safest approach because many sleep medications cause memory impairment and increase the risk of falling.

Aerobic Power and Functional Independence in Older Adults

Wednesday, July 1, 2015 - 14:30

We all know that keeping fit as we age is important, but what does this truly mean? Often the focus is on strong muscles, which makes sense – more muscular strength leads to increased stamina and an improved ability to carry out activities of daily living. Until fairly recently, however, the contribution of aerobic capacity (VO2 max, also known as maximal oxygen consumption, or aerobic power) has been less understood. VO2 max is the highest rate at which oxygen can be consumed, or taken in, during exercise. The more oxygen you are able to taken in, the higher your threshold for exercise intensity will be. Picture competitive runners, or even the fit runner passing you on the street – they are working hard yet their breathing is controlled and even. They are able to take nice deep breaths yet still continue to exercise at a fairly high intensity. Contrast this with an unfit person trying to run for the first time – short, raspy, rapid breaths. That person cannot yet supply his muscles with enough oxygen to produce much adensine tryphosphate (ATP) – the energy molecule that is the foundation of everything our bodies are able to do. VO2 max can be compromised by various medical conditions, including heart disease chronic obstructive pulmonary disease, asthma, diabetes, cancer, osteoporosis, and osteoarthritis.

Maximal oxygen consumption is not just a boring subject in exercise physiology– it is critical to the maintenance of functional independence in older adults. Research demonstrates that aerobic power declines steadily in sedentary males by almost half between the ages of 20 and 60 (from about 45 ml/kg/min to 25 ml/kg/min). In females, the decline generally begins at around age 35 and drops by one-third by age 60 (from about 38 ml/kg/min to 25 ml/kg/min). The evidence suggests that older adults whose VO2 max has dropped to about 12-15 ml/kg/min are very challenged to complete the activities of daily living necessary to live autonomously. Seniors who live independently tend to have VO2 max values of at least 18 ml/kg/min for men, and or 15 ml/kg/min for women. An inactive lifestyle can, over the course of years, insidiously chip away at maximal oxygen consumption – rendering independent living a pipe dream. Given that the most prevalent fear in the senior population is losing independence, maintaining sufficient VO2 max is critical in order to avoid and/or delay the move to assisted living or long-term care.

The good news is that it is possible to increase maximal oxygen capacity in older adults, just as in younger individuals. In fact, a 12.9% increase can be realized after just 8-10 weeks of training; a 14.1% increase after 12-18 weeks; and a 16.9% increase after 24-52 weeks. Gradually increasing aerobic training can boost the aerobic power of the elderly by at least 10 ml/kg/min, potentially delaying the loss of independence by as much as 20 years. When seniors exercise at a higher intensity, even more dramatic gains are realized.

Exercise Specialist Recommendations for Older Adults:

Exercise at a moderate intensity. This is about a 6 or 7 out of 10 in terms of intensity - meaning that you can carry on a conversation, but not sing a song.

Incorporate interval training. Even older adults can do intervals! Do them informally by walking faster for 1-2 minutes, then dropping back down to the previous intensity. This is very easy to do on fitness equipment which has adjustable speed.

Take the stairs whenever the opportunity presents. Do not opt for the easy way out by taking the escalator or elevator. Learn to view stairs as one of the keys to a life of prolonged independence.

Determine the time of the day when your energy level is highest, and schedule your workouts accordingly. While most people tend to experience higher adherence to an exercise program when working our first thing in the morning, those with arthritis or other musculoskeletal conditions may need to wait a few hours for the fluid inside joints to warm up, facilitating ease of movement.

Include strength training. By lifting weights and participating in other exercises that improve muscle strength, the foundation for higher intensity cardiovascular training – the kind that increases functional capacity – is established. Not everyone enjoys strength training, so it is advantageous to view it as good medicine, as opposed to a leisure activity.

Exercise “Vital Sign”

Monday, June 1, 2015 - 14:30

Adding a vital sign for exercise as an assessment tool in clinical settings could improve patient care, according to research published in the official journal of the American College of Sports Medicine. This study, in the November edition of Medicine & Science in Sports & Exercise, demonstrates that asking patients about their exercise habits is an important piece of a patient’s care and treatment that is often ignored.

“This research offers preliminary support that implementing an exercise vital sign in addition to the traditional vital signs— pulse, blood pressure, temperature, and respiration’s— in a large health care system is very possible and could offer many benefits as well as additional patient data,” said the primary investigator, Karen Coleman, Ph.D, of Kaiser Permanente’s Department of Research and Evaluation.

The authors reviewed data from April 2010 to March 2011 from more than 1.7 million outpatient visits to Kaiser Permanente Southern California. Kaiser Permanente began using the exercise vital sign in October 2009. Patients at Kaiser are routinely asked questions about their usual daily levels of activity and are assigned a minutes-per-week value based on their answer. Using a regression model, this study demonstrated that physical inactivity increased disease burden among the sample patient population. As expected, researchers also found lower activity levels among patients who were older, obese or members of ethnic minorities.

“There is no better indicator of a person’s health and longevity than the minutes per week of activity a patient engages in,” said Robert E. Sallis, M.D., one of the authors and also the chairman of the Exercise is Medicine advisory board. “When incorporated in a healthcare setting, the exercise vital sign can be an important tool for prevention and management of disease.”